Atrial fibrillation incidence after coronary artery bypass graft surgery and percutaneous coronary intervention: the prospective AFAF cohort study

Figures & data

Figure 1. Study flow-chart. LOS: length of stay; mo: months.

Figure 2. Study design.

Table 1. Preoperative patient characteristics.

	PCI group (n = 123)	CABG group (n = 123)	p-Value
Age	67 ± 9	67 ± 8	.903
Female sex (%)	29% (35/123)	9% (11/123)	<.001
BMI (kg/m^2)	28 ± 4	29 ± 5	.009
Smoking status
Current	11% (14/123)	9% (10/119)
Former	42% (51/123)	41% (49/119)
Non-smoker	47% (59/123)	50% (60/119)	.714
Alcohol consumption/week
>8 glasses	6% (7/119)	6% (7/118)
<8 glasses	86% (102/119)	86% (101/118)
None	8% (10/119)	8% (10/118)	1.000
Congestive heart failure	2% (3/123)	13% (16/120)	.002
Previous MI	40% (49/123)	43% (41/120)	.673
COPD	4% (5/123)	1% (1/120)	.213
OSA	3% (4/123)	5% (6/120)	.493
Hypertension	67% (82/123)	68% (82/120)	.782
Diabetes mellitus	17% (21/122)	34% (40/119)	.003
Previous stroke/TIA	5% (6/123)	6% (7/119)	.557
Peripheral vascular disease	2% (3/123)	6% (7/120)	.183
CHADS-VASc median (IQR)	3 (2)	3 (2)	.334
HAS-BLED median (IQR)	2 (1)	1 (1)	.160
Indication for PCI/CABG
Unstable	14% (17/123)	21% (26/123)
Stable	54% (66/123)	50% (62/123)
NSTEMI	32% (40/123)	29% (35/123)	.310
No. of diseased vessels
1	62% (76/123)	3% (4/123)
2	35% (43/123)	16% (19/123)
3	3% (4/123)	81% (100/123)	<.001
LA Area (cm^2)	21 ± 5	21 ± 5	.887
LVEF (%)	57 ± 8	55 ± 11	.135
CABG
No. of peripheral		3 ± 1
LIMA		90% (110/123)
PCI
No. of treated segments	2 ± 1
DES	97% (119/123)
BMS	1% (1/123)
Unknown	2% (3/123)
Medication
Aspirin	87% (107/123)	90% (111/123)	.422
Clopidogrel	32% (39/122)	2% (2/123)	<.001
Ticagrelor	37% (46/123)	4% (5/123)	<.001
Beta blockers	50% (61/123)	74% (91/123)	<.001
ACE-inh/ARB	55% (68/123)	66% (81/123)	.090
MRA	1% (1/122)	7% (8/123)	.036
Statins	73% (90/123)	85% (105/123)	.018
DOAC	0	0
Warfarin	0	0
LMWH	2% (2/123)	9% (11/123)	.010

BMI: body mass index; MI: myocardial infarction; COPD: chronic obstructive pulmonary disease; DOAC: direct oral anticoagulants; OSA: obstructive sleep apnea; TIA: transient ischemic attack; NSTEMI: non-ST-elevation myocardial infarction; LA: left atrium; LVEF: left ventricular ejection fraction; CABG: coronary artery bypass grafting; PCI: percutaneous coronary intervention; DES: drug-eluting stent; BMS: bare metal stent; ACE-inh/ARB: angiotensin converting enzyme inhibitor/angiotensin receptor blocker; MRA: mineralocorticoid receptor antagonist; LMWH: low-molecular-weight heparin.

Data are mean ± standard deviation, % (n), or median (interquartile range).

Figure 3. Cumulative new-onset AF incidence. CABG: coronary artery bypass graft; PCI: percutaneous coronary intervention.

Table 2. In-hospital and discharge data.

	PCI group (n = 123)	CABG group (n = 123)	p-Value
AF >30 s	0% (0/123)	49% (60/123)	<.001
Asymptomatic		50% (30/60)
Paroxysmal		91% (55/60)
Persistent		2% (1/60)
Permanent		0
Not classified		7% (4/60)
Diagnosis
Telemetry		98% (59/60)
Zenicor II		2% (1/60)
Median day of onset		2
Median duration (days)		2 (1–4)
AF at discharge	0% (0/123)	5% (6/123)	.013
SR at discharge	100% (123/123)	95% (117/123)	.013
Hospital mortality	0	0
Thromboembolic events	0	1% (1/123)	1.0
Pericardial exudate	1% (1/123)	3% (4/123)	.370
Cerebral hemorrhage	0	0
Cardiac ischemic events	0	2% (2/123)	.498
Heart failure	0	0
Bleeding requiring intervention	2% (3/123)	8% (10/123)	.046
Medication
Aspirin	99% (122/123)	98% (120/123)	.313
Clopidogrel	49% (60/123)	3% (4/123)	<.001
Ticagrelor	50% (61/123)	15% (18/123)	<.001
Beta blockers	70% (86/123)	95% (117/123)	<.001
ACE inh/ARB	75% (92/123)	58% (71/123)	.005
MRA	2% (2/123)	6% (7/123)	.172
Statins	98% (121/123)	94% (116/123)	.172
OAC/DOAC	0	23% (28/123)	<.001
Dabigatran	0	0
Rivaroxaban	0	0
Apixaban	0	6% (7/123)	.014
Edoxaban	0	1% (1/123)	1.00
Warfarin	0	16% (20/123)	<.001
LMWH	1% (1/123)	2% (2/123)	1.00

AF: atrial fibrillation; SR: sinus rhythm; ECG: electrocardiography; ACE-inh/ARB: angiotensin converting enzyme inhibitor/angiotensine receptor blocker; MRA: mineralocorticoid receptor antagonist; OAC: oral anticoagulation; DOAC: direct oral anticoagulants; LMWH: low-molecular-weight heparin.

Data are presented as % (n), n, or median (interquartile range). Thrombomembolic events was defined as any venous or arterial symptomatic and clinically diagnosed embolic episode, such as deep vein thrombosis, pulmonary embolism, arterial embolic ischemia.

Table 3. Predictors of new-onset atrial fibrillation 30 days postoperatively.

	Univariate analysis OR (95% CI)	p-Value	Multivariate analysis OR (95% CI)^a	p-Value
CABG vs. PCI	51.1 (15.4–169.6)	<.001	80.2 (18.1–354.9)	<.001
Age	1.05 (1.01–1.08)	.009	1.08 (1.03–1.13)	.002
Congestive heart failure	4.86 (1.83–13.0)	.002	2.65 (0.78–9.0)	.118
Diabetes mellitus	1.49 (0.8–2.77)	.214	0.77 (0.35–1.72)	.526

CABG: coronary artery bypass grafting; CI: confidence interval; OR: odds ratio; PCI: percutaneous coronary intervention.

^aWith all variables in the table.

Table 4. 30-Day follow-up.

	PCI group (n = 123)	CABG group (n = 123)	p-Value
Follow-up by telephone	95% (117/123)	93% (114/123)	.313
AF >30 s	2% (3/123)	56% (69/123)	<.001
Asymptomatic	25% (31/123)	38% (47/123)	.001
Dyspnea	1% (1/123)	11% (13/123)	<.001
Palpitations	0	12% (15/123)	<.001
Fatigue	0	10% (12/123)	<.001
Paroxysmal	2% (3/123)	33% (40/123)	<.001
Persistent	0	1% (1/123)	<.001
Permanent	0	0
Unknown	0	23% (28/123)
Mortality	0	0
Thromboembolic events	1% (1/123)	1% (1/123)	1.00
Pericardial effusion	0	2% (3/123)	.247
Cerebral hemorrhage	0	0
Cardiac ischemic events	1% (1/123)	1% (1/123)	1.00
Heart failure	0	1% (1/123)	1.00
Bleeding requiring intervention	0	1% (1/123)	.122
Medication
Aspirin	97% (119/123)	89% (109/123)	.014
Clopidogrel	48% (59/123)	3% (4/123)	<.001
Ticagrelor	46% (57/123)	14% (17/123)	<.001
Beta blockers	68% (84/123)	96% (118/123)	<.001
ACE inh/ARB	76% (94/123)	70% (86/123)	.250
MRA	1% (1/123)	5% (6/123)	.120
Statins	98% (120/123)	94% (116/123)	.197
Dabigatran	1% (1/123)	2% (3/123)	.472
Rivaroxaban	0% (0/123)	1% (1/123)	.316
Apixaban	1% (1/123)	17% (21/123)	<.001
Edoxaban	0% (0/123)	1% (1/123)	1.00
Warfarin	1% (1/123)	27% (34/123)	<.001
LMWH	1% (1/123)	2% (2/123)	1.00
OAC/DOAC	2% (3/123)	48% (60/123)	<.001
DAPT	90% (111/123)	12% (15/123)
DAT	2% (2/123)	37% (45/123)
TAT	1% (1/123)	24% (3/123)

AF: atrial fibrillation; ACE-inh/ARB: angiotensin converting enzyme inhibitor/angiotensine receptor blocker; MRA: mineralocorticoid receptor antagonist; OAC: oral anticoagulation; DOAC: direct oral anticoagulants; DAPT: dual antiplatelet therapy; DAT: dual antithrombotic therapy; LMWH: low-molecular-weight heparin; SR: sinus rhythm; TAT: triple antithrombotic therapy.

Data are presented as % (n), n, or median (interquartile range).

Data availability statement

Data will be made available upon request, please contact the corresponding author.